On April 16, 2007, Seung-Hui Cho, a 23-year-old student at Virginia Tech University, fatally shot 32 students and faculty members and wounded others on the Blacksburg campus before taking his own life. After the tragedy, hundreds of colleges and universities across the United States and around the world expressed their condolences and offered support. Administrators, faculty, counselors, students, and parents almost certainly wondered, "Could this happen on our campus?"

Eileen Bazelon '65

On September 24, 2007, Bryn Mawr College hosted a conference, "Dangerous Behavior on College Campuses," to examine student behaviors that are dangerous to oneself or others. The conference focused on the effect of those behaviors on the student and others in the college community, and appropriate responses of other students, administrators, counselors, and faculty. Six professionals with diverse backgrounds in law, bioethics, and mental health awareness offered their perspectives on the issues through presentations, a panel discussion, and group discussions with conference participants.

"I felt that everybody was really floundering in the wake of the Virginia Tech incident about how to respond to people who are dangerous to themselves or others," recalled conference organizer, Eileen Bazelon '65, a psychiatric consultant for Bryn Mawr College's Counseling Service. "Dangerous behavior to oneself is a big problem for colleges, which are often caught between individual students' rights and response to the community. I thought it would be great to get together a group of experts to talk about our options."

Threat Assessment

Gary Pavela

Keynote speaker Gary Pavela, director of Judicial Programs at the University of Maryland-College Park, made it clear that this was not a security conference. "Technology clearly has its role; it needs to be available for prompt notification in the event of an incident," he said, "but the danger would be if we let technology become our primary focus when there are deeper issues."

Pavela, an attorney who has served as a fellow at the Wisconsin Center for Behavioral Science and Law, observed, "We know, of course, that the connection between mental illness and violence is tenuous—insufficient to draw firm conclusions about the future behavior of any particular student, especially if there has been no related pattern of substance abuse or past violence."

However, after a study of pertinent federal and state legislation and case law, Pavela has concluded that if a student's behavior poses a direct threat to himself or herself or to others, an academic institution can take action, such as suspending the student from campus. "The law is reasonably balanced: we can hold students accountable; we do not have to accept violent or threatening behavior."

Pavela suggested a "threat assessment" approach based on "analyses of observable behavior compiled from multiple sources and reviewed by a threat assessment team" of experienced professionals, including law enforcement officers. He stressed that any policy about disruptive behavior on campus should apply both to students and faculty.

Effective communication is of key importance. "If we can foster a channel of communication between students and administration, we have a much better opportunity to identify threats of violence," Pavela said.

Reasonable Accommodations

Karen Bower

All too often, when students express suicidal thoughts or have other mental health issues, colleges and universities respond with involuntary suspension, in the experience of Karen Bower, an attorney with the Judge David L. Bazelon Center for Mental Health Law in Washington, D.C. Two high-profile cases brought by the Bazelon Center have shown this to be a flawed policy.

In October 2006, the Bazelon Center announced that George Washington University (GWU) and one of its former students reached an agreement to resolve the lawsuit filed by the student against the university and several other entities regarding his October 2004 mental health hospitalization, his interim suspension by GWU, and his subsequent withdrawal from GWU. The settlement came in the second lawsuit to challenge a university's exclusion of a student who has sought mental health services. And in August 2006, the City University of New York agreed to pay $165,000 to settle a suit brought by the Bazelon Center on behalf of a student who had been barred from her dormitory room at Hunter College because she was hospitalized after a suicide attempt. Both universities agreed to review and revise their policies for such situations.

The Bazelon Center's goal in bringing these and other such cases, beyond obtaining compensation for students who have been unfairly excluded, is reform of educational institutions' policies toward students who seek mental health services. In May 2007, the Bazelon Center released a model policy to help colleges and universities develop a nondiscriminatory, nonpunitive approach to students in crisis because of mental health problems. A set of best practices, "Supporting Students: A Model Policy for Colleges and Universities," was developed by Bazelon Center attorneys after consultation with mental health experts, higher education administrators, counselors, and students.

"One of the key ideas we express is that the disciplinary process not be used for a student expressing or engaged in self-injury, such as suicidal ideation," Bower explained during the panel discussion at the conference. "It sends a message that the student does not belong, and it discourages him or her from seeking help.

"The other central concept is confidentiality," Bower continued. "There should be a 'firewall' between the counseling center and the administrative areas of the academic institution unless the student poses an imminent risk."

Indeed, Bower says, schools should be committed to the success of all students, including those with mental illness. Their policies should avoid actions that discourage students from seeking help. Moreover, they should provide reasonable accommodations that help students who wish to stay in school to do so.

"One of the most reasonable accommodations is to make voluntary leave available and remove the barriers, such as termination of insurance, for a student who wishes to take a leave," Bower said. "Involuntary leave should rarely be used; that is, only when there are safety issues."

Bower stressed, "The law says a high threshold must be met."

Emergence Response Planning

Leading up to the tragic shootings at Virginia Tech, Cho had expressed violent notions, both verbally and in his writings, and he had engaged in stalking behavior. Although various individuals and departments of the university were aware of these incidents, the university did not intervene effectively. "No one knew all the information and no one connected all the dots," stated the findings of the Virginia Tech Task Force, which was established by Virginia Governor Tim Kaine to review the events leading up to the tragedy; the manner in which it was handled by the university, first responders, and public safety officials; and the services provided to families, survivors, care-givers, and others in the university community.

Carroll Ann Ellis

Carroll Ann Ellis, director of the Fairfax County Police Department's Victim Services Division and a member of the task force, provided an overview of the key findings, which identified 21 major issues that negatively affected response to the events that unfolded on the Blacksburg campus. These included communication failures, inadequate provision of counseling and support services to Cho, misunderstanding of mental health and privacy laws, premature conclusions drawn by university police in the aftermath of the initial double homicide, and a slow, uncoordinated response to the needs of survivors and families.

"There is a need for internal systems that work, including a judicial process that is credible and responsible, so if someone presents or reports behavior that is disturbing, there is a process to look at it in a meaningful and serious way, evaluate it, and make the hard calls that are sometimes necessary," Ellis said. "Universities need to demand accountability."

The task force issued more than 70 recommendations concerning security, emergency preparedness and response, mental health procedures, and weapons policies. "Colleges and universities ought to be on the cutting edge of technology for notification purposes," Ellis remarked in a follow-up interview. "An emergency response plan should be developed in collaboration with the surrounding community, including law enforcement, first responders, the health system, and social services. Once a plan is developed, there ought to be periodic desktop exercises to get it right."

In the aftermath of an event in which there are mass casualties, whether it is a shooting, natural disaster, or health emergency, Ellis emphasizes the need for a response plan that takes into account the needs of victims. "As I understand it, Virginia Tech's crisis response plan was outdated and did not take into account the special needs of victims, who must always be at the forefront of any crisis response plan," she said. "As the news came out about what had happened at Virginia Tech, parents started to flood the campus with phone calls, and there wasn't a way to obtain the information they needed. I also believe that death notifications must involve both law enforcement and mental health professionals, who can speak to the immediate crisis reactions."

Red Flags

Mark Olshaker

Mark Olshaker, an author and Emmy Award-winning filmmaker who has studied criminal psychology and behavior, cautioned against making assumptions about a person's potential for violence based on his or her appearance or demeanor. However, he said that the findings of FBI and Secret Service studies of "campus shooters" should raise red flags about certain characteristics and behaviors of persons such as Cho. For example, he said, "They are not usually comfortable talking about their problems to others, but they leave elaborate diaries and videos to justify themselves.

"They are fighting an internal war between grandiosity and self-esteem," Olshaker continued. "They tend to be functionally paranoid, that is, very organized in their planning."

Moreover, Olshaker said, "The gun is the great equalizer."

Most individuals who display these behaviors do not actually commit violent acts. However, Olshaker emphasized, "If you have severe chest pains or other serious symptoms, that demands a medical work-up. By the same token, if you have a student whose writings display violent ideas, it demands a similarly comprehensive work-up."

Olshaker has noticed that individuals who are violent toward themselves or others often act during a period of transition. "We find over and over that most events take place among people who are coming to the end of something," for example, during their senior year of high school or college.

Individual vs. Community

Arthur Caplan

Arthur Caplan, chair of the Department of Medical Ethics at the University of Pennsylvania, observed that one of the difficulties in publicly identifying individuals who may be dangerous to themselves or others has to do with what he described as Americans' cultural aversion to "snitching."

In fact, there are a number of problems associated with "blowing the whistle" on such a person. "We are afraid to make errors," Caplan observed. "There is a moral stigma attached to being a 'snitch,' a betrayer of trust. We want to be welcoming of diversity on campus. And there is skepticism as to whether a mental health intervention will make a difference in the person's life."

To counter these concerns and encourage faculty, students, and others to identify troubled persons who may be a danger to themselves or others, Caplan said they need to hear that there are benefits to the campus community of doing so.

That raises the issue of the rights of the individual versus those of the community. "There is no doubt that autonomy of the individual is not absolute, but we operate under that ethos in our culture," Caplan said. "But it is important to educate students and faculty that they are part of a community, and the good of the community is also important.

"Autonomy has its limits," Caplan asserted, "especially in a close community."

Student Voice

Alison Malmon

Who is often the first to know when a student is at risk? Other students, maintains Alison Malmon, founder and executive director of Active Minds, Inc., a nonprofit organization that focuses on engaging young adults in raising awareness of mental health issues. "Students are a largely untapped, underutilized voice on college campuses," she said. "Our mission is to utilize the student voice to raise mental health issues, reduce the stigma around these issues, and create connections between students and professional mental health services."

Creating these connections is vital. "Suicide is the second leading cause of death among college students in the United States, at more than 1,100 a year," Malmon said, yet "eighty percent of those suicides are students who have not been seen by college counselors."

Malmon formed Active Minds in 2001, following the suicide of her 22-year-old brother, Brian. She created a group on her campus at the University of Pennsylvania to promote an open, enlightened dialogue around the issues. Today Active Minds has more than 100 chapters across the United States and Canada, including a chapter at Bryn Mawr College, which is led by Katharine Penzo '09.

In a follow-up interview, Malmon said, "I would like to take the words 'safe' and 'dangerous' out of the equation altogether. When we talk about safety and danger, we are equating anyone with a mental health issue as dangerous. That is highly stigmatizing for these students, and they become discouraged from coming forward and talking about their stories.

"I think our emphasis should have much more to do with comfort, wellness, and success for students," Malmon maintained. "The administration and faculty should institute wellness classes in the freshman year to educate students about the opportunities to maintain wellness through yoga and other stress-relief activities. Counselors can help educate faculty and residence hall advisers about mental health issues. Every partner in the campus community needs to have an understanding of the issues students are facing and the best way to address those issues."

Hepling Students Succeed

Following the conference, Bazelon summed up three key conclusions reached by participants. "Suicide and suicidal behavior is a mental health issue, not a disciplinary issue," she said, "and should not be handled by a college or university as a disciplinary issue.

"At the same time," she continued, "we acknowledged that students and other members of the campus community can usually say what they want to say, and, certainly, think what they want to think, but they can't do everything they feel like doing—if someone's behavior is very much out of line with standards that a college has promulgated, then they are at risk of being asked to leave, at least temporarily, until they can get their behavior under control."

Finally, Bazelon said, "I think that one of the most important things that happened at the conference is the recognition that we have students who have a lot of difficulties, and we need to determine how we can best serve them, help them to get a college education, and help them be successful, yet keep our campuses safe. All the colleges are committed to that—we are certainly committed to that at Bryn Mawr."

About Our Sources

Eileen A. Bazelon '65 is a clinical assistant professor at the Drexel University College of Medicine Department of Psychiatry. Since 1975, she has maintained a private practice of adult, adolescent, and child psychiatry, and has served as a psychiatric consultant to Bryn Mawr College's Counseling Service. Bazelon earned her medical degree from the Medical College of Pennsylvania (MCP). She completed a residency in adult psychiatry and a fellowship in child psychiatry at MCP and Eastern Pennsylvania Psychiatric Institute. Bazelon is a member of the American Board of Psychiatry and Neurology and the American Board of Child Psychiatry. She serves as a board member of the Judge David L. Bazelon Center for Mental Health Law, Washington, D.C., which is named for her late father-in-law [www.bazelon.org].

Karen A. Bower, Esq., is a senior staff attorney with the Judge David L. Bazelon Center for Mental Health Law. Bower works on a broad array of issues that affect adults and children with mental illnesses. She has been a public-interest lawyer for more than a decade, most recently as supervising attorney with the D.C. Law Students in Court Program. She also served as staff attorney with the ACLU National Prison Project. Bower is a graduate of the Georgetown University Law Center.

Arthur Caplan is the Emanuel and Robert Hart Professor of Bioethics, chair of the Department of Medical Ethics, and director of the Center for Bioethics at the University of Pennsylvania. Caplan is the author or editor of 25 books and more than 500 papers in refereed journals of medicine, science, philosophy, bioethics, and health policy. His most recent book is Smart Mice, Not So Smart People. Caplan is a fellow of the Hastings Center and the American Association for the Advancement of Science. He earned a bachelor's degree from Brandeis University and a Ph.D. in the history and philosophy of science from Columbia University.

Carroll Ann Ellis is director of the Victim Services Division of the Fairfax County Police Department, Fairfax, Va. Her work includes programs tailored to meet the specific needs of victims based on crime category, training, technical assistance, community intervention, and standards for police responses to domestic violence victims. She served on Governor Tim Kaine's Virginia Tech Independent Review Panel. Ellis, who has a master's degree in psychology, has authored numerous articles, manuals, and textbook chapters, including Emergency Forensic Medicine.

Alison Malmon is founder and executive director of Active Minds, Inc., which is dedicated to engaging young adults in the mental health awareness movement [www.activemindsoncampus.org]. She serves on the National Suicide Prevention Lifeline Consumer/Recipient Subcommittee and the Judge David L. Bazelon Center for Mental Health Law Leadership 21 Committee. In 2003, Malmon became the youngest-ever recipient of the Tipper Gore Remember the Children Award from the National Mental Health Association. Malmon earned a bachelor's degree from the University of Pennsylvania.

Mark Olshaker is an award-winning filmmaker and author. His novels include Einstein's Brain, Unnatural Causes and The Edge. Olshaker wrote the nonfiction book, Mindhunter (and six other books), with John Douglas, the FBI special agent who pioneered personality profiling and criminal investigative analysis. Olshaker is a member of the Writers Guild of America-East and a fellow of the American Board of Forensic Examiners. He lives in the Washington, D.C., area.

Gary Pavela is director of Judicial Programs at the University of Maryland-College Park, and edits the national quarterly journals, Synthesis: Law and Policy in Higher Education and Synfax Weekly Report [www.garypavela.com]. Pavela earned a master's degree in intellectual history from Wesleyan University and a law degree from the University of Illinois. He has been a fellow at the University of Wisconsin Center for Behavioral Science and Law. He serves as a consultant on legal issues and student conduct policies for colleges and universities.

Dorothy Wright contributes news and feature articles on science, technology, engineering and general-interest topics to a variety of publications, including Civil Engineering and Engineering News Record.